Care Home: Besford House

What the care home does well Staff support people in a variety of ways to take their medicines. The support offered takes into account each person`s individual needs and choices. The system used for ordering medicines is robust, with very little waste produced whilst ensuring that people have enough medication in stock. Staff who are authorised to handle medicines have recently updated their medication training. Well trained staff are less likely to make mistakes. In order to ensure that people who are new to this service are given their medicines correctly, staff confirm their current medication with the GP before they are admitted. What the care home could do better: The service should audit (check) all aspects of handling, administering and recording medication regularly in order to identify any areas of weakness. The results of the audit and any action taken should be recorded. A second member of staff should check and double-sign any handwritten entries on medication administration record charts in order to reduce the risk of mistakes. There should be clear, personalised information recorded for people who are prescribed medicines to be taken only `when required` so that staff are able to give these medicines safely and consistently. In order to protect people who use this service, the competence of all staff who are authorised to handle medication should be checked regularly. Policies and procedures should be personalised to Besford House so that staff have clear guidelines to refer to at all times. Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Besford House 19 Besford Road Liverpool L25 2XT one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Maggy Howells Date: 0 3 0 2 2 0 0 9 Information about the care home Name of care home: Address: Besford House 19 Besford Road Liverpool L25 2XT 01514984281 01514880944 sally.jones@liverpool.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Liverpool City Council care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 18 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 18 Date of last inspection Brief description of the care home Besford House is owned and run by Liverpool Social Services. The home provides support and personal care to 18 younger persons who have a learning disability. The home consists of three bungalows each accommodating six people in single bedrooms. One of the bungalows accommodates 6 people who live at the home on a permanent basis whilst the other two provide respite care and emergency care. Each bungalow has its own domestic style kitchen, laundry room, sitting room and dining room. Each bungalow has assisted baths and a walk in shower with additional aids provided as and when required. The home is situated in the Belle Vale area of Liverpool and is easily accessible by public transport and is close to shops and other community facilities. Parking is available. At the time of the inspection, the weekly cost for the service was Care Homes for Adults (18-65 years) Page 2 of 11 Brief description of the care home £366.00 with the people who use the service making a weekly contribution to this overall cost depending on their benefit entitlements. A statement of purpose, which describes the services offered at Besford House, is available for relatives and social and health care professionals to refer to. A service user guide is available for people interested in using the service. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: We visited this service because the lead inspector had some concerns about how medicines were handled and recorded. The visit was carried out by a pharmacist inspector. It lasted four hours and involved speaking with the person in charge of the service. We checked the medicines storage areas, a sample of medicines stocks and medicines records. We gave detailed feedback to the person in charge throughout the visit, and repeated the main findings to them at the end of the visit. Overall we found that most medicines were given correctly. There were some areas of practice that could be further improved so as to better protect the health and wellbeing of people who live in the home. We looked at a sample of records and stock. Most medicines were stored in blister packs supplied by the pharmacist and these had been given correctly. However we found it difficult to account for a few medicines that were supplied in bottles and boxes and some gaps on the medication records. This meant that we could not be absolutely sure that medicines had been given to people correctly. When the administration of medicines is not accurately recorded, people are at risk of being given the wrong amount of medicine (too much or too little). Some people were prescribed medicines to be taken only when required e.g. painkillers. There was no formal system for recording detailed information about how and when these medicines were to be given. Having clear written information helps to ensure that people are given their medicines consistently and correctly. We looked at the storage of medicines and found that the service had an appropriate trolley available. Medicines were taken to the individual houses in a locked container, and whilst this was acceptable, there were concerns that the practice may place the safety of the medicines and staff at risk of harm. Advice was given about current storage solutions that are available including the option of storing medicines securely in peoples rooms. No controlled drugs (medicines that can be misused) were kept at the time of the visit. The person-in-charge told us that no formal audits (checks) of the medicines handling system were carried out at the moment, although there were plans to start doing this soon. When audits are not carried out, it means that mistakes are not found and action cannot be taken to prevent them happening again. An audit that looks into all aspects of handling, administering and recording medication is important to help maintain and improve standards. We looked at training and found that staff who were authorised to handle medication, had completed appropriate trainings within the last two months, but there was no formal system of checking and recording the competence of staff actually performing this task. Checking the competence of staff ensures that staff have understood the training and are safe to carry out their duties without supervision. Policies and procedures for handling medication were available, but did not accurately reflect all aspects of the service offered at Besford House. These documents should be personalised to Besford House so that staff always have clear guidelines to refer to at Care Homes for Adults (18-65 years) Page 4 of 11 all times. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 5 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 2 14 (1) (a) The registered persons must 10/06/2008 ensure that a service is only provided to people whose needs can be met at the home and who do not present a significant risk to other people using the service. This is to ensure that the welfare of the people using the service is safeguarded and promoted at all times. 2 3 18 (1) (c) The registered persons must 10/06/2008 ensure that staff have the right skills and training to meet the needs of the people admitted to the service. This is to ensure that the people who use the service are appropriately supported at all times. 3 6 15 (1) and (2) (b) The registered person must 10/06/2008 ensure that care plans provide staff with the information they need to appropriately support the people using the service. Evidence that care plans and risk assessments are kept under review needs to be available so as to demonstrate that staff have Care Homes for Adults (18-65 years) Page 6 of 11 access to up to date information. 4 18 13 (4) (c) The registered persons must 10/06/2008 ensure that an assessment of an individuals needs takes place prior to the use of bed rails, that a full risk assessment is in place around the continuing use of bed rails that includes staff being trained in the safe use of bed rails by an appropriately qualified person. This is to ensure the safety of the people using the service. 5 20 13 (2) The registered persons must 10/06/2008 ensure that medication is held securely at all times so as to ensure the safety of the people using the service. 6 23 37 (1) (e) The registered persons must 10/06/2008 inform the CSCI of any event in the care home which adversely affects the well being or safety of any service user. This is needed so that the CSCI can ensure that the home is operating in the best interests of the people who are living there. 7 30 18 (1) (a) The registered persons must 10/09/2008 ensure that there are sufficient permanent staff available to promote continuity of care for the people who use the service. (Previous timescale of 25/07/07 not met.) Care Homes for Adults (18-65 years) Page 7 of 11 8 32 17 (3) (b) The registered manager 10/06/2008 must ensure that the records specified in Schedule 4 of The Care Homes Regulations 2001 are at all times available for inspection in the care home by the CSCI. This is to ensure that evidence that staff have been appropriately recruited and trained can be viewed during the inspection visit. 9 33 18 (1) (a) The registered persons must 10/09/2008 ensure that there are sufficient permanent staff available to promote continuity of care for the people who use the service. (Previous timescale of 25/07/07 not met.) 10 34 17 (3) (b) The registered manager 10/06/2008 must ensure that the records specified in Schedule 4 of The Care Homes Regulations 2001 are at all times available for inspection in the care home by the CSCI. This is to ensure that evidence that staff have been appropriately recruited and trained can be viewed during the inspection visit. 11 39 24 (1) The registered persons must 10/09/2008 ensure that there are effective quality assurance and quality monitoring systems in place so that shortfalls in the service provided are identified and a plan put in place to address them. Page 8 of 11 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 9 of 11 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 24 The service should audit (check) all aspects of handling, administering and recording medication regularly in order to identify any areas of weakness. The results of the audit and any action taken should be recorded. A second member of staff should check and double-sign any handwritten entries on medication administration record charts in order to reduce the risk of mistakes. There should be clear, personalised information recorded for people who are prescribed medicines to be taken only when required so that staff are able to give these medicines safely and consistently. In order to protect people who use this service, the competence of all staff who are authorised to handle medication should be checked regularly. Policies and procedures should be personalised to Besford House so that staff have clear guidelines to refer to at all times. Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!